Swine flu, Round 2

OpEd

Rates of infection with H1N1 influenza in the United States are down
from their peak in April but still running well ahead of what is normal
for this time of year; many summer camps, for instance, have been
reporting flu outbreaks.

And history suggests that we are likely to experience a much bigger,
second wave of the pandemic early in the fall, perhaps before a vaccine
is widely available. Argentina, Australia, Chile and New Zealand, where
the winter flu season has just begun, are all experiencing major
outbreaks.

Fortunately, so far, most people infected with the H1N1 virus have
had relatively mild symptoms, like those you get with ordinary seasonal
flu.

Even so, during the spring wave in New York City, hospital emergency
departments experienced a flood of patients — most of them
children. Some emergency rooms had several times their normal volume of
patients for several weeks. Hospitals in such widespread areas as Texas
and California reported similar experiences.

When this kind of overload happens, all patients, not just those
with flu, have to endure delays and reduced quality of care. And this
is what we should prevent this fall.

The good news is that only a small percentage of patients have been
sick enough to require hospital care beyond the emergency department.
Even fewer patients have required intensive care. Nonetheless, stories
of young patients who become critically ill with the H1N1 flu,
requiring sophisticated and prolonged intensive care, are emerging
around the world.

There is the real possibility that, during the fall months, some
hospitals will become short of ventilators and other lifesaving
equipment.

Many of our hospitals are already dangerously overburdened, plagued
by chronic shortages of personnel, especially of the most highly
trained nurses, respiratory therapists and radiology and laboratory
technicians — precisely the people we need most to treat victims
in a pandemic.

There are steps that, if taken now, could lessen the stress on our
hospitals this fall. First, we must work to reduce the number of flu
patients who go to emergency departments with mild symptoms. This will
involve both educating the public on proper responses to the flu and
offering good alternatives to emergency department care.

The public needs to be informed that most flu patients can be
adequately treated at home with fluids, rest and over-the-counter
medications (acetaminophen or ibuprofen for fever, for example). State
and local health departments should urge doctors and clinics to extend
their hours temporarily and, if necessary, add employees. In some
communities, temporary flu clinics may need to be established and
manned by volunteers.

For their part, hospitals should plan to maximize the number of
workers available for their emergency departments and intensive care
units.

This may mean canceling or postponing vacations, instituting
mandatory overtime and reassigning personnel from other departments.
They can also minimize the number of people absent because of illness
by ensuring that staff members are inoculated as soon as a vaccine
against H1N1 is available and monitoring proper use of masks, gowns and
gloves.

Most important, hospitals should cooperate with one another, and
with public health agencies, to distribute patient loads, stockpile
supplies and share limited resources.

Certainly, this will require financial support from federal, state
and possibly also local county and city governments. But hospitals,
other health care providers and governments must prepare together
— starting immediately — to cope with the large number of
flu patients expected soon.

Dr. Eric Toner, a specialist in emergency medicine, is a
senior associate with the Center for Biosecurity at the University of
Pittsburgh Medical Center. He is a widely cited author on a range of
biosecurity issues, including hospital preparedness, pandemic influenza
response, and clinical issues related to bioterrorism
response.